I was welcomed back to the United States with those infamous words, "is there a doctor or a nurse on board" over the loud speaker of the airplane. Though I was the closet to the patient and the first to volunteer, I was happy to hand over my responsibilities to the doctor that eventually came from the back of the plane. Besides, there was not too much that anyone could do for shortness of breath related to pulmonary hypertension in mid-air other than apply the oxygen mask. Until that trip, I never knew how many gadgets and medical contraptions were hiding out in that first overhead bin on the airplane. Though we were met by EMS when we taxied into the gate, the patient walked off the plane without difficulty. Needless to say, it was an eventful homecoming.
DD Photo_with baby
This week one of my prenatal patients that I had been caring for since I first arrived here in Xela had her baby. She was a gestational diabetic, so although she had had her last 5 children at home with a comadrona she agreed to go to the public hospital for the delivery. She borrowed a cell phone from her neighbor to call me when she started went into labor and decided to go to the hospital. I met her there as soon as a finished seeing my patients at the clinic. I couldn't play any major role at the hospital, but I think it was good to see a familiar face; she cried when she saw me at the OB triage station.
Nyamata, Rwanda

The last few weeks I have been leaving the Nyamata Hospital to work in the community health centers. Getting to the centers often entails a few hours of travel in a four-wheel drive over rough, dirt roads. There are 11 centers in the Burgessa district and more than 400 in Rwanda.

These health centers are the front line healthcare for most Rwandans. Each center is responsible for a population of roughly 20,000 people. Patients using the public hospitals must start at these community based centers. If the case is complicated, they are transferred to a district hospital like Nyamata. The staff care for sick patients, deliver babies, provide vaccinations, distribute food given from the government and non-governmental organizations. They also have daily classes on topics such as family planning, gardening for nutrition, and proper sanitation and food preparation. These centers are truly the best hope the country has in the areas of disease prevention and early intervention.
Do you remember the story of Olken Foncime? He was the Haitian orphan who had congenital heart disease and received surgery from Dr. Christian Gilbert in October.

We just received a photo and an update. His doctor reports that since the surgery, he has gained 10 lbs. and has a remarkable increase in activity. He's doing really well.

Thanks to Dr. Gilbert for the update!
December 1, 2009

by Jenny Dyer, Ph.D.

Last night, Senator Frist spoke at Vanderbilt University's Student Life Center to over 250 friends, students, faculty, and guests in honor of World AIDS Day. The title of the talk: "Celebrating Life, Mourning Death: Continuing the Fight against Global AIDS" focused on where we've come from and where we're going, especially in terms of policy. Recounting his personal experiences in Africa with the AIDS pandemic and how he was able to use those experiences to shape and inform President Bush's decision to move forward to commit historic funding to fight a single virus, the Senator relayed the beginning of the President's Emergency Plan for AIDS Relief (PEPFAR) in 2003.
Everyone in Xela is getting geared up for Christmas and consequently the patient load throughout the clinic is winding down. This week marks the last week of women's group meetings for the year. They will start again in January. I lead the closing project with the Tierra Colorada Baja group today. We made fertility necklaces out of brown, black, cream and red wooden beads. The placement of the different colors on the necklace indicate when the woman is most fertile and can be used either for family planning or to help conceive. The project was a big hit, but most importantly it sparked some interesting conversation and important questions.
I have now transitioned to working with the physicians. Each physician is responsible for admitted patients on one of the floors and seeing patients in the outpatient consultation area. This change has been eye-opening.

Each morning starts at 7:00 with prayers, singing, and a short sermon. Watching my colleges sing and dance is an incredible way to start the day. By 7:30 we start rounds. There are usually about 40 patients to see and it has to be finished by 9:30 when the outpatient consulting begins.
Belmont University hosted an event today with Senator Bob Corker announcing his co-sponsorship of the Paul Simon Water for the World Act of 2009. Joining Senator Corker included water activists Dan Haseltine and Jars of Clay with Blood: Water Mission, Dave Barnes with Mocha Club, and Bill Hearns of EMI for Healing Water International.
Nyamata, Rwanda: Today

Although the Rwandan genocide occurred fifteen years ago, I see its impacts everyday in the hospital. The region I live in was an area of great violence. There is a memorial site here in Nyamata were 10,000 people crammed into a small church seeking refuge, only to be killed. It is hard to believe that the reserved, kind spirited people I know went through such a horrible event.
To be a practitioner in Guatemala, one needs to find harmony between western and traditional medicine. I had never thought about or tried natural herbal medicine before coming to Guatemala. Though I still don't usually recommend it to my patients, I have begun exploring the natural remedies so that I can hopefully help my patients to navigate their own health. The women's program teaches patients that if their symptoms do not improve after two days of at home treatment with herbal remedies, they need to go to the doctor for medication.

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